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The  clinical  history 


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CLLNICAL  HISTORY  L\  OUTLINE 


THE 

CLINICAL  HISTORY 

IN  OUTLINE 


By  I 

PAUL  G.  WOOLLEY,  S.  B.,  M.  D.  | 

Professor  of  Pathology,  College  of  Medicine,  University  M 

of   Cincinnati;  Director  of    Laboratories,  = 

Cincinnati  General  Hospital,  J 

Cincinnati,   Ohio  = 


ST.  LOUIS 

C.  V.  MOSBY  CO. 

1914 


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Copyright,  1914,  by  C.  V.  Mosby  Company 


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-    30TS  ^ 


I'rcss  of 

The  C.  V .  Mosby  Company 

St.   Louis 


PREFACE. 

The  object  in  taking  a  clinical  history  has  always 
been  to  discover  the  condition  from  which  a  person 
is  suffering,  and  to  discover,  if  may  be,  the  causes  of 
the  condition  in  order  that  treatment,  medical  or  sur- 
gical, may  be  instituted  and  the  diseased  condition 
cured.  It  is,  however,  becoming  realized  more  and  more 
generally  that  a  thorough  clinical  history  may  have  a 
distinct  value  in  forming  the  basis  of  educational  meas- 
ures Avhich  will  teach  a  patient  how  to  avoid  recurrences 
of  a  disease  from  which  he  is  suffering,  and  how  to  avoid 
sequela?  of  the  disease. 

In  some  instances  the  diseased  condition  is  an  obvious 
one  which  demands  but  few  questions  to  decipher  it. 
In  other  instances  no  detail  is  so  small  that  it  is  unim- 
portant, and  yet  in  the  former  instances  many  questions 
and  a  very  complete  history  may  be  necessary  to  dis- 
cover the  cause  or  causes.  In  the  latter  case  the  same 
thing  is  obvious.  Therefore  it  happens  that  judgment 
is  necessary  in  taking  a  history,  as  well  as  in  treating  a 
patient.  Judgment  and  tact  are  both  necessary,  the 
proportions  varying  with  the  character  of  the  patient. 

Such  a  volume  as  this  makes  no  attempt  to  take  auto- 
matically a  clinical  history.  It  is  intended  merely  as 
a  sort  of  reminder  of  points  to  be  considered,  and  also 
it  is  intended  to  offer  a  systematic  scheme  by  following 
which  a  student  may  be  enabled  to  arrange  the  facts 
concerning  a  patient  in  an  orderly  way.  It  is  not  in- 
tended to  replace  such  excellent  volumes  as  McKisack's 
"Systematic  Case  Taking."  It  is  modelled  upon  Striim- 
pell's  "Leitfaden  f.  d.  klin.  Krankenuntersuchungen. " 

The  Cincinnati  Hospital.  P.  G.  W. 


CONTENTS 


CHAPTER  I. 

Page 

Foreword 9 

Data  Required  in  History  Taking   10 

CHAPTER  II. 

The  Complaint  of  the  Patient  in  His  Own  V/ords 11 

The  Family  History   12 

Personal  History    13 

History  of  Present  Illness  15 

The  Physical  Examination   16 

The  General  Appearance  of  the  Patient 16 

Anatomic  Data   17 

Outline  of  Organs,  Especially  of  Liver  and  Stomach..  22 

Special  Examinations 23 

Acute  Infectious  Diseases   24 

Diseases  of  the  Respiratory  System   25 

Diseases  of  the  Cardiovascular  System   26 

Gastro-Intestinal  Diseases  27 

Central  Nervous  System   28 

Past  History  of  Other  Nervous  Disturbances 28 

Urinary  Diseases   30 

CHAPTER  III. 

Data  Referring  to  Certain  Frequent  Symptoms 32 

Data  Referring  to  Pain 41 

CHAPTER  IV. 

Post-Mortem  Examinations  and  Records 48 

Form  of  Post-Mortem  Record  50 


(7) 


CLINICAL  IIISTOIIY  IN  OITLIXK 


CHAPTER  I. 

Foreword 

In  taking  the  clinical  history  of  a  patient  there  are 
several  items  which  demand  close  attention.  The  most 
important  of  these  is  never  ask  leading  questions.  Many 
a  person  can  be  made  to  tell  a  story  which  is  sometimes 
untrue,  often  misleading,  by  asking  (luestions  which 
seem  to  indicate  the  answer  desired  by  the  physician. 
Another  is,  ahvaijs  insist  upon  definite  ansiocrs,  when- 
ever it  is  possible.  Another  is,  never  ask  embarrassing 
questions  in  the  presence  of  a  third  party.  Learn  to 
use  tact.  If  a  patient  is  very  ill,  wait  for  his  own  his- 
tory, and  rely  largely  upon  relatives,  or  friends,  or, 
as  often  must  happen,  upon  the  physical  examination. 
If  you  receive  ({uestionable  answers,  repeat  your  query 
in  new  and  different  forms,  and  at  different  times.  But 
above  all  treat  every  patient  as  you  would  treat  any 
other  human  being.  Don't  l)e  rough  or  sharp  except 
when  occasion  demands.  Such  occasions  are  few.  At 
the  same  time,  don't  trust  a  patient's  statement  over- 
much. It  is  especially  true  in  public  hospitals  that  the 
patients  are  dull  and  ignorant.  The  physical  examina- 
tion is  the  most  important  part  of  any  history.  When  in 
doubt,  trust  that. 

Don't  forget  that  your  ((uestions  may  be  misunder- 
stood; that  the  patient  may  be  very  ignorant;  that  he 
may  be  intentionally  misleading  you  (malingering)  ; 
that  he  is  afraid  or  embarrassed.  Take  everything  with 
a  grain  of  salt  except  what  you  discover  with  the  add 
of  your  special  senses. 

(9) 


10  CLINICAL   HISTORY    IN    OUTLINE. 

Data  Required  in  History  Taking 

In  taking  the  history  of  a  patient  it  is  customary  to 
place  the  following  data  at  the  head  of  the  first  sheet : 

Name. 

Age. 

Date. 

Address.  City.  Street.  No. 

Social     Condition:      Single — Married — Widower     or 

Widow — Divorced. 
Race. 

Occupation. 
Place  of  Birth. 
Name  of  nearest  relative  or  friend. 

Remarks. 

Certain  of  these  data  are  for  the  purpose  of  identify- 
ing patients,  and  for  placing  the  physician  or  hospital 
authorities  in  a  position  to  communicate  with  relatives 
or  friends.  In  some  instances  a  certain  amount  of  sug- 
gestive information  is  furnished  in  the  answers. 

The  age  has  a  certain,  more  or  less  definite,  relation 
to  the  incidence  of  certain  diseases,  for  instance,  types 
of  tumors. 

The  address  may  be  of  value  in  epidemiologic  studies 
of  series  of  cases,  for  instance,  of  typhoid,  cerebro-spinal 
fever,  etc. 

The  ejeeupation  may  have  a  relation  to  occupational 
intoxications  (lead,  phosphorus,  benzol)  or  to  occupa- 
tional neuroses  (eyestrain,  writer's  cramp,  etc.). 

The  place  of  birfh  may  suggest  such  pathologic  pos- 
sibilities as  hydatid  disease,  kala-azar,  leprosy,  malaria, 
etc. 


CHAPTER  ir. 

A.  Anamnesis  includes  the  information  derived  from 

the  patient  or  his  relatives  or  friends. 

I.  The  Comph'iint. 
II.  Family  History. 

III.  Personal  History   (or  Past  History). 

IV.  Present  Hlness. 

B.  Status  pra'sens    (present   condition)    includes   the 

information   derived   from   an   examination   of 
the  patient. 

I.  Physical  examination. 

II.  Special  examination. 

The  Complaint  of  the  Patient  in  His 
Own  Words 

Remarks. 

This  is  always  the  first  item  of  the  history  and  should 
invariably  be  in  the  words  of  the  patient  and  should 
be  elicited  by  a  question  w^hich  is  not  leading ;  i.  e.,  the 
physician  asks,  "Why  have  you  come  to  the  hospital?" 
and  the  patient  says,  "For  a  pain  in  the  stomach." 
This  item  is  therefore  placed  at  the  head  of  the  history, 
"The  patient  complains  of  'a  pain  in  the  stomach,'  " 
not  ' '  The  patient  says  he  has  an  abdominal  pain. ' ' 

With  certain  patients  it  may  be  useful  to  allow  them 
to  tell  their  whole  story  at  this  time,  although  this  story 
belongs  under  Present  Illness  (q.  v.). 

(11) 


12 


CLINICAL   HISTORY    IN    OUTLINE. 


Fatlu'i- 
Mother 
Brothers 
Sisters 


The  Family  History 

(Hereditary  Rehitionships.) 

Living  or  dead ;  if  alive — state  of  health. 
If  dead,  cause  of  death. 

Remarks. 


Ill  the  case  of  each  individual  note  the  occurrence  of 
any  abnormality,  or  deformity  that  has  show^i  any 
hereditary  tendency  (supernumerary  fingers,  or  toes; 
hemophilia;  color  blindness;  albinism;  alcaptonurnia : 
pentosuria;  diabetes;  gout). 

Make  especial  note  of  infectious  diseases,  or  other  con- 
ditions which  have  shown  a  tendency  to  affect  other 
members  of  the  family  ( ' '  tuberculosis  "  ;  ' '  lung  f evei' ' ' ; 
"spinal  disease";  ''consumption";  "rheumatism"; 
"kidney  disease";  "stomach  troubles";  "cancers"; 
"nervous  disease";  "brain  troubles";  "insanity"). 

The  family  history  is  of  especial  value  in  nervous  and 
mental  conditions;  in  states  due  to  precocious  arterio- 
sclerosis; and  in  tu])erculosis.  It  has  a  certain  general 
scientific  value  in  the  study  of  congenital  and,  especially, 
hereditary  disorders.  It  is  I'dntivdy  unimportant  in 
most  infectious  diseases. 


THE    PERSONAL    lILsTORY.  13 

Personal  History 

The  Previous  History  (including  former  diseases  suf- 
fered by  the  patient  and  in  certain  eases  the 
name  and  address  of  the  physician  who  was  in 
attendance,  or  the  hospital  in  which  he  was  eared 
for,  and  the  dates). 

Diseases  of  ehiklhood.     These  should  be  specified. 

Measles. 
Mumps. 

Whooping  cough. 
Diphtheria. 
Scarlet  fever. 
Chicken-pox. 

Olher  infectious  discoses.     (More  than  one  attack?) 

Pneumonia.      (More  than  once?) 
Pleurisy.      ( Character. ) 
Tonsillitis.     (More  than  once"?) 
Typhoid.     (In  bed  how  long?) 
Malaria.      (Chills— how  often?) 
Smallpox.     (Pock-marks?)      (Vaccination.) 
Rheunuitism.      (Distribution.) 
Syphilis.      (When?) 
Gonorrhtea.      (More  than  once?) 
Dysentery.     (Type.) 

Sequela?  of  the  foregoing. 

Hys  f  e  m  diseas es . — 

Digestive  disorders — Sour  stomach,  belching, 
vomiting  (character),  diarrha^a  constipa- 
tion, pain. 


14  CLINICAL    HISTORY   IN    OUTLINE. 

Respiratory  disorders — Cough,  expectoration, 
coryza,  pain  in  chest,  shortness  of  breath. 

Cardiovascular  disorders — Palpitation,  short- 
ness of  breath. 

Renal  (urinary)  disorders — Frequency  of  uri- 
nation (day  and  night),  swelling  of  feet,  diffi- 
culty of  urination,  pain,  headache. 

Nervous  disorders — Headache,  dizziness,  con- 
vulsions, paralysis,  epilepsy,  dreams  (char- 
acter). 

Traumata  (accidental). 

Menstrual  History. — 

Appearance    (age),  regular,  irregular,  charac- 
ter, duration,  pain. 

Marital  History. — 

Number  years  married. 
Health  of  husband  or  wife. 
Leucorrhoea — date  of  appearance. 
Miscarriages   (age  of  fetuses). 
Number  of  children. 
Labors —  ( normal — instrumental ) . 
Puerperium — fever,  chills,  time  in  bed. 
(Domestic    relationships.       Happy,    unhappy. 
Reasons.) 

Residences. — 

Location. 

Sanitary    surroundings     (open    closets,    baths, 

etc.) 
Water  supply. 


TiiK  i'i:rs()nal  history.  15 

Tlohil^.     (c-r.  also  occupations.) 

Hours  ot*  work. 

Hours  of  leisure    ( I'ecreatioiis). 

Food — No.    niejils,   appetite,   likes  niul   dislikes, 

cotl^ee,  tea. 
Di'ug's — C'ocain,     iiiorpliiii.    heroin,    elilorororin, 

etc. 
Alcohol — No.  glasses  beer  oi'  spirits  per  day. 
How  niiieli   water  eousuiued. 
Plow  much  sleep. 

0('('\(pali(tn. — 

Sui'rouiidiugs — \vn\  ilat  ion,     illumination,     toi- 
let facilities,  drinking  cups,  coniuion  towels. 
Continuous  woi-k  ;  rest  ]HM'iods ;  I'est   rooms. 
Safety  devices. 
Sickness  anu)ng  associates. 
Habits  of  associates — spitting  on  tioor,  etc. 

History  of  the  Present   Illness 

Date  of  onset. 

Manner  of  onset — first  symptom. 
When  was  w^ork  discontinued  ? 
When  did  patient  take  to  bed? 

Can  walk  now?     How  far? 
Ts  present  illness  similar  to  other  previous  ones? 

Character,  duration  of  each  ;  dates. 
The  general  opinion  of  ihv  palioif  regarding  ids  ill- 
ness and  its  cause. 


16  CLINICAL   HISTORY    IN    OUTLINE. 

The  Physical  Examination 
The  General  Appearance  of  the  Patient. — 

Position  or  attitude  (in  bed  or  standing). 

Lies  on  side,  on  back,  on  face.  Legs  and  arms 
drawn  up  or  extended.  Stands  erect,  bent ; 
jactitation. 

Gait.— 

Si3astic,  ataxic,  reeling,  pseudo-ataxic,  step- 
page, waddling,  lameness. 

( U) n  ditio n   of    nutntio  n . — 

Well-nourislied,  wasted,  emaciated,  weight, 
obese,  anasarcous. 

Skin. — 

Dry,  moist,  hot,  cold,  pale,  flushed,  cyanotic, 
greenish-yellow,  yellowish,  p  i  g  m  e  n  t  e  d, 
bronzed,  jaundiced,  rough,  smooth,  satiny, 
desquamation,  erythema,  petechia?,  haemor- 
rhages, tumors,  parasites,  birth-marks,  na?vi, 
papules,  macules,  vesicles,  wheals,  pustules, 
scars. 

Snhrutancous  sivelUnf/s. — 

Periosteal  nodules,  painful  jioinls. 

Expression. — 

Anxious,  vacant,  stupid,  staring,  placid,  ex- 
cited, pinched,  mask-lik(\  satui-nine.  pnffy. 
acromegalic,  hippocratic,  paralytic. 


TFIE    PHYSICAL   EXAMINATION'.  17 

Menial  Condi  Hon. — 

Intelligent,   apathetic,  dull,  stupid,   emotional, 

delirous.    . 
Hallucinations,   hypochondriac,   comatose. 
Memory. 

Odor  surrounding  the  patient. 

Speech. — 

Articulation,  aphasia. 

Anatomic  Data. — 

Lymph  nodes. — 

(Cervical,  suboccipital,  supraclavicular,  axil- 
lary, epitrochlear,  inguinal  mesenteric.) 

Small,  large,  firm,  soft,  fluctuating,  tender, 
painful,  not  adherent,  adherent,  discrete, 
conglomerate. 

Head.— 

Large,  small,  symmetrical,  asymmetrical,  hy- 
drocephalic, rachitic. 

Fontanelles — Open,  closed.  Areas  of  tender- 
ness.    Cranio-tabes. 

Hair — Scanty,  abundant,  thin,  thick,  fine, 
coarse,  color. 

Face — Symmetric,  asymmetric. 

Eyes. — 

Pupils,  dilated,  contracted,  ei|ual,  unequal, 
shape,  reflexes  (Argyll-Robertson). 


18  CLINICAL    HISTORY    IN    OUTLINE. 

Arcus  senilis. 

Strabismus,  nystagmus,  exophthalmus. 
Amaurosis,  hemianopsia,  retinitis. 
Conjunctiva — Pale,  congested,  inflamed. 
Eyelids — Edema,  ptosis,  chalazion. 

(Special  ophthalmic  examination  when  necessary,) 

Ears. — 

Tophi,  stigmata   (Darwinian  tubercle). 

Deafness,  discharge,  wax,  foreign  bodies. 

Tympanum. 

Mastoid  tenderness.     Position  of  concha. 

(Special  otologic  examination  when  necessary.) 

Nose. — 

Deformities — ' '  Saddle-back, "    "  Bardolphian. ' ' 
Ozaena,  epistaxis,  discharge. 

(Special  rhinologic   examination  when  necessary.) 

Mouth. — 

Salivation,  stomatitis. 

Lips — Color,    deformities     (hare-lip),    fissures 

(rhagades),  herpes,  ulcerations. 
Breath — Sweet,  clean,  foetid,  alcoholic,  acetone 

( diabetic ) ,  urinous. 

Tongue. — 

Color,  dry,  moist,  clean,  coated,  smooth,  rough, 
fissured,  ulcerated,  ''geographical,"  leuco- 
plakia,  mucous  patches,  strawberry. 

Protrusion,  symmetrical,  deviation,  tremor. 


THE   PHYSICAL   EXAMINATION.  19 


Gums.- 


Color,  inflamed,  spongy,  hsemorrhagic,  pig- 
mented (lead),  pyorrhoea  alveolaris. 

Teeth.— 

Number,  condition,  decay,  fillings,  deformities 
(Plutchinson's). 

(Special  dental  examination  when  necessary.) 

Pharynx. — 

Adenoids,  tonsils,  inflammation,  membrane,  ab- 
scesses. 
Reflexes,  paralyses. 
Uvula,  long,  short,  inflamed,  congested,  edema. 

Larnyx. — 

Voice,  husky,  aphonia. 

(Special  examination  when  necessary.) 
Neck. — 

Shape — Long,  thin,  short,  thick.  Supraclavi- 
cular fossae. 

Muscles — Prominence  in  dyspnoea. 

Blood  vessels — Venous  pulsation.  Diastolic 
(venous  stasis).  Systolic  (tricuspid  insuffi- 
ciency). 

Salivary  glands — Tumors,  pain. 

Thyroid — Tumors,  assoc.  with  exopthalmus. 

Thymus — Enlargement. 

Larynx — Tracheal  tug. 

Spinal  column — Curvatures. 

Cysts — Branchial. 


20  CLINICAL   HISTORY   IN   OUTLINE. 

Thorax — (Heart  and  Lungs). 

Inspection. — 

Shape — Pigeon  breast,  rickety  chest  (rickety 
rosary),  funnel  chest,  barrel  chest  (emphy- 
sema), scoliotic,  kyphotic,  paralytic,  later- 
ally compressed,  symmetric,  asymmetric, 
bulging. 

Expansion — Rhythmic,  arrhythmic,  symmetri- 
cal, asymmetrical,  slow,  rapid,  free,  labored, 
costal,  costo-abdominal,  Cheyne-Stokes ', 
Biot's. 

Apex  beat,  normal  position,  displaced.  Broad- 
bent's  sign. 

Palpation. — Fremitus,  thrills,  pulsations,  friction 
rubs. 

Pulse — Small,  large,  hard,  soft,  (|iiiek,  slow, 
anacrotic,  dicrotic,  collapsing,  regular,  irreg- 
ular. 

Auscultation. — 

Breath  sounds,  vesicular,  puerile,  broncho- 
vesicular,  tubular,  amphoric,  cog-wheel, 
stridor. 

Voice  sounds — vocal  resonance  (increased  or 
decreased) ,  bronchophony,  pfH'torophmiy, 
aegophony. 

Adventitious  sounds — Rhonchi,  i'  Ics  (crepi- 
tant, su])crepitant,  mucous,  metallic).  Fric- 
tion sounds,  bell  sounds,  metallic  tinkling, 
succussion. 


THE    PHYSICAL    EXAMINATION,  21 

Heart  sounds — Normal,  accentuated,  weak, 
rhythm,  tachycardia,  bradycardia,  redupli- 
cation, gallop,  murmurs,  localization. 

Percussion. — 

Resonance — Tympanitic,  dull,  increased,  Sko- 
diac,  decreased,  amphoric,  metallic,  Win- 
trich's  sign,  cracked-pot. 

Cardiac  dullness,  lateral  measurements  from 
mid-sternal  line. 

Exploratory  puncture. — Pleura.     Pericardium. 

Abdomen. —  (Stomach,  intestines,  liver,  spleen,  kid- 
neys.) 

Inspection. — 

Enlarged  veins,  caput  medusse. 
Linai  alhicantes,  eruptions,  rose-spots. 
Shape,  retraction,  '^scaphoid,"  meteorism. 
Movements  —  respiratory  —  pulsations,  muscu- 
lar, gastric,  intestinal. 
'  Enlarged,  organs — position  of  organs. 

Palpation. — 

Tumor  masses,  tenderness,  ascites,  rigidity. 
Spleen,   kidneys,   liver   edge,   surface   of   liver, 

gall   bladder. 
Vaginal  exploration. 
Rectal  exploration. 

Auscultation. — 

Friction  rubs,  aneurismal  bruits,  fetal  heart, 
borborygmi,  splashing  sounds. 


22  CLINICAL    HISTORY   IN    OUTLINE. 

Percussion. — 

Areas  of  dulness. 
(Auscultatory  percussion.) 

Exploratory  puncture. — 

Ascites;  splenic  enlargements. 

Outline  of  Organs,  Especially  of  Liver  and  Stomach. 

Genitalia. — 

Abnormalities. 

Scars. 

Tumors. 

Evidence  of  discharge  (signs  of  irritation). 

Bacteriological  examination. 
Digital    examination    of    prostate,    tubes,    ovaries, 
uterus. 

Central  Nervous  System. — 

Disturbances  of  motion — weakness,  paralyses,  etc. 
Disturbances  of  sensation — anaesthesia,  pariethesia. 
''Trophic"  disturbances. 
Disturbances    of    special    senses — seeing,    hearing, 

taste,  smell. 
Reflexes — skin,   tendon,   inuscle, 
When  necessary,  examination  of  cerebrospinal  fluid : 

Wassermann. 

Globulin. 

Cell  count. 

Bacteriologic. 


THE    PHYSICAL    EXAMINATION.  23 


Blood. 


Hemoglobin  per  cent. 

Leucocytes  per  cu.inm. 

Red  cells  per  cu.mm. 

When  necessary,  serum  reactions: 

Wassermann. 

Widal. 


Urine. — 


Amount — 24  hours. 

Albumin. 

Casts. 

Reaction  (Litmus,  methyl  red). 

Sugar. 

When  necessary,  complete  urine  examination. 


Feces. — 


Appearance,  formed  or  unformed;  consistency. 
Microscopic. 

Undigested  food. 

Parasites. 
When  necessary,  complete  examination. 
Blood. 


Special  Examinations 

There  are  but  few,  if  any,  cases  in  which  a  general 
history  is  not  of  value.  Often  it  suggests  certain  sys- 
tem diseases  or  diseases  of  a  specific  nature.  Under  such 
conditions  additional  data  should  be  collected  and  added 
to  the  general  history. 


24  clinical  history  in  outline. 

Acute  Infectious  Diseases. 

Especial  Reference  to  Previous  Diseases  of  an  In- 
fectious Character. — 

Tyj^hoid,  measles,  scarlet  fever,  usually  occur 
but  oiice  in  the  same  individual. 

Pneumonia,  acute  articular  rheumatism,  erysip- 
elas are  not  infreiiuently  recurrent. 

Social  Surro undings. — ■ 

Hygienic  conditions — (Brill's  disease,  typhus, 

tuberculosis,  smallpox) . 
Occupation. 

Early  Symptoms. — 

Chills,  headache,  pain,  vomiting,  diarrhoea, 
eruption. 

Appearance  at  Time  of  Ejcamination. — 

Temperature,  pulse,  respiration. 

Condition  of  nutrition. 

Mental  condition. 

Color  of  cheeks  and  lips. 

Type  of  re.spiration. 

Herpes  labialis. 

Physical  Examination. — 

Evidence  of  foci  of  infection. 

Middle  ear  disease. 

Tonsils,  carious  teeth,  pyori'ho'a  alveolaris, 
adenoids. 

Glandular  involvement. 

Genital  infection. 
Joint  or  muscle  pain. 


SPECIAL    EXAMINATIONS.  25 

Blood  Examination. — 

Leucocytes. 
Differential  count. 
Cultures. 
Serum  reactions — 

Wassermann. 

Widal. 
Complement  deviations. 

Urine  Examination. — 

Albumin,  casts. 

Reaetion  (preferably  with  Methyl  red). 

Bacteriologic. 

Feces. — 

Bacteriologic. 

Animal  I  hoc  iil  at  in  us. 

Sputum. — 

Bacteriologic. 

m 

Diseases  of  the  Respiratory  System. 

Occupation. 

Social  Snrroundincjs. 

Onset. — Gradual  or  rapid. 

Symptoms — cough,  chill,  i)ain,  etc. 


26  CLINICAL    HISTORY    IN    OUTLINE. 

Special  detmJed  examination  of  thorax,  and  upper 
respiratory  tract. 

Sputum. — 

Time  of  expectoration ;  night,  morning. 

Effect  of  position. 

Appearance — color,  consistency. 

Odor. 

Microscopic — 

Parasites. 

Bacteria. 
Bacteriologic  examination  complete. 

Special    laryngologic    examination ,    including    the 
character  of  voice. 

Diseases  of  the  Cardiovascular  System. 

History  of  Past  Infectious  Diseases. — 

Rheumatism,    scarlet    fever,    diphtheria,    influ- 
enza, tonsillitis,  syphilis,  gonorrhoea. 

Habits. — 

Alcohol,  tobacco,  over-eating,  athletics. 

Psychic  conditions. — 
Worry. 

Special  Detailed  Examination  of  Peripheral  Vascu- 
lar System. — 

Pulse. 


SPECLVL    EXAMINATIONS.  27 

Character    of    vessels — (temporal    and    radial 

vessels). 
Polygraphic  studies. 

Special  Detailed  Examination  of  Heart  and 
Lungs. — 

Evidence  of  general  cardiac  involvement. 

Evidence  of  special  valvular  or  myocardial  con- 
ditions. 

Galvanometric  studies. 

Evidence  of  pulmonary  congestion,  liver,  spleen, 

Sputum — Character. 

Urine — Chronic     congestion.       Secondary    ne- 
phritis. 

Blood — Bacteriologic. 

Blood  Cultures. 

Gastro-Intestinal  Disease>s. 

Past  History  of  Dietary  Hahits,  including  alcohol- 
ism and  tobacco. 

Sedentary  life ;  nervous  conditions ;  amount  of 
sleep. 

Occupation. — 

(Lead,  arsenic,  mercury,  antimony.) 

State  of  Nutrition  and  General  Appearance. 

Special  Gastric  and  Intestinal  Examinatio7is. — 
Symptoms  in  detail. 


28  CLINICAL    HISTORY   IN    OUTLINE. 

Chemical  examination  of  gastric  juice — 
Acids,  ferments,  etc. 

Microscopic  and  bacteriologic  examination 
of  gastric  washings. 

Motility- 
Radiographic  examination. 

Special  chemical  tests — 

Blood  lipase  (liver  conditions). 
Phenosulphoi)hthalein. 

Special  Examination  of  feces. — 

Character  and  quantity. 

Microscopic. 

Blood. 

Bacteriologic. 

Parasites — 

Amoebae. 

Ova. 

Central  Nervous  System. 

Fauiilfj  History. — 

Valual)le  in  cases  of  epilepsy,  general  nervous- 
ness, hysteria,  and  vHi-ious  psychic  disorders.. 

Past  History. — 

Infectious  diseases,  especially  syphilis. 
Rheumatism. 

Past  History  op  Other  Nervous  Disturbances. 

Convulsions  in  childhood. 
Migraine. 


SPECIAL   EXAMINATIONS. 

Traumata. 

Psychic  disturhances — 

Shock. 
Worry. 
Grief,  etc. 

Intoxications. — 

Lead. 

Arsenic. 

Alcohol. 

Habits  and  Surroundings. — 

Nervous — irritable. 

Headaches. 

Epileptic  attack  (order — sequeiice) 

Cerehral  System. — 

Headache. 

Dizziness. 

Loss  of  memory. 

Sight.      (Reflexes.) 

Hearing-— Taste. 

Speech — Sense  of  smell. 

Vomiting. 

Paralyses. 

Sensation. 

Aphasias. 

Spinal. — 

Pain. 

Girdle  sensations. 


21) 


30  CLINICAL   HISTORY   IN    OUTLINE. 

Retention  of  urine,  incontinence. 
Constipation,  involuntary  excretion. 
Sexual  side — increase  or  decrease  of  desire  or 
ability. 

Motor. — 

Weakness. 
Paralysis. 
Cramps. 
Convulsions. 

Sensory. — 

Paraesthesia. 
Anesthesia. 

Urinary  Diseases. 

Past  History. — 

Infectious  Diseases — Syphilis,  diphtheria,  scarlet 
fever. 

Habits. — 
Alcohol,  diet. 

Occupational  Jufoxications — Lead,  etc. 

Exposure  to  extremes  of  temperature. 

Swelling  of  Feet,  Ankles. 

Frequency  of  urination. 

Amount  of  urine ;  color ;  sediment. 


SPECIAL   EXAMINATIONS.  31 

Headache,  dizziness,  loss  of  appetite. 

Asthma,  dyspnoea. 

Vision. 

Physical  Examination. — 

Paleness;  pnffiness  of  eyelids. 
Arteriosclerosis. 
Albuminuric  retinitis. 
Cardiac  hypertrophy. 
Character  of  pulse. 
Ascites,  General  edema. 

Special  Urinanj  Examination.     (Total  amount  in  24 
hours. ) 

Microscopic. 

Complete  chemical  examination. 

Phthalein  tests. 

Special  Examination  of  Bladder^  Ureters  and 
Kidneys. — 

Digital  exploration. 

Cystoscopy.     Ureteral  catheterization. 

Radiographic  examination. 


CHAPTER  III. 

The  following  data  refer  to  certain  frequent  symp- 
toms. In  each  case  the  symptom  precedes  the  names  of 
conditions  with  which  the  symptom  may  be  associated. 
These  lists  are  merely  suggestive  and  do  not  pretend  to 
be  complete.  For  fuller  discussions  of  symptoms  one 
may  consult  Cabot's  "Differential  Diagnosis''  and  other 
similar  volumes. 

Ascites. — 

Portal  obstruction. 

Cardiac  disease. 

Tuberculous  peritonitis. 

Carcinomatous  peritonitis. 

Chronic  peritonitis. 

Ovarian  tumors. 

Chronic  pulmonary  disease. 

Hydra?mia. 

Chronic  Bright 's  disease. 

Distomiasis. 

Hradjjcardia.     (Pulse  below  60  per  minute.) 

Convalescence  from  fevers  (Diphtheria,  influenza). 

Circulatory  diseases  (Chronic  myocarditis,  Stokes- 
Adam's  disease,  aortic  stenosis). 

Urinary  diseases  (Chronic  ncplii-itis). 

Nervous  diseases  (Intracranial  i)ressure,  menin- 
gitis). 

Cretinism. 

Intoxications  (Alcohol,  tobacco,  digitalis). 

(32) 


FREQUENT   SYMPTOMS.  33 

Tachycardia.     (Pulse  above  120  per  minute.) 

Fevers. 
Tuberculosis. 
Anaemia. 
Neurasthenia. 
Graves'  disease. 
Hysteria. 

Shock  and  collapse. 
Abdominal  distension. 
Peritonitis. 

Certain  cardiac   diseases    (Endocarditis,   pericardi- 
tis). 

Chills.— 

Sepsis. 

Infectious  disease. 
Gall-stone  disease. 

Color  of  Skin. — 

Yellow — jaundice. 

Lemon  yellow — anaemia,  esp.  chlorosis. 

Bronzing — Chronic  tuberculosis. 

Addison's  disease. 

Extozoic  infections   (pediculosis). 

Pregnancy. 

Hodgkin's  diseases. 

Hepatic  cirrhosis. 

Diabetes  (bronzed). 
Blue-gray — Argyria. 

Coma. — 

Alcoholism. 
Apoplexy. 


34  CLINICAL    HISTORY    IN    OUTLINE. 

Uraemia. 
Diabetes. 
Meningitis. 
General  paralysis. 
Brain  tumors. 
Poliomyelitis. 

Contimied  Fever. — 

Typhoid. 

Sepsis. 

Tuberculosis. 

Meningitis. 

Influenza. 

Infectious  arthritis. 

Renal  suppurations. 

Hepatic  suppurations. 

Leukaemia. 

S3'philis. 

Cardiac  infections. 

Diseases  of  Infancy. — 

Diarrhoea. 

Rickets. 

Scurvy. 

Convulsions  ( eelampsic ) . 

Disorders  of  dentition. 

Thymic  enlargements. 

Diseases  of  Pifherfij. — 

Chlorosis. 
Tuberculosis. 
Nervous  diseases. 


FREQUENT   SYMPTOMS.  35 

Diseases  of  Childhood. — 

The  erythematous  fevers. 

Diseases  of  Old  Age. — 

Arteriosclerosis. 
Carcinoma. 
Chronic  arthritis. 
Emphysema  (pulmonary). 

Hereditary  Diseases. — 

Certain  Nervous  Diseases. 

Diabetes. 

Gout. 

Hemophilia. 

Albinism. 

Pentosuria. 

Neoplasia. 

Progressive  muscular  dystrophy. 

Cerebellar  ataxia. 

Friedrich's  ataxia. 

Vocational  or  Occupational  Diseases. — 

Occupational  neuroses — 

Writer's  cramp. 

Telegrapher's  cramp. 

Singer's  cramp. 
Caisson  disease. 
Housemaid's  knee. 
Konioses — (Pneumokoniosis) — Dust  diseases. 

Anthracosis  (miners). 

Siderosis  (iron-workers,  grinders). 

Aluminosis  (potters). 


36  CLINICAL   HISTORY   IN    OUTLINE. 

Silicosis  (stonecutters). 

Tobaccosis  (tobacco  workers). 

Other  forms  occur  in  Avood  workers,  sawyers, 
furriers,  hair  pickers,  etc. 
Industrial  poisonings — 

Lead     (painters,     type-founders,     compositors, 
paint  makers). 

]>enzol     (painters,     varnish     workers,     rubber 
workers). 

Arsenic    (dyers,    etchers,    taxidermists,    textile 
printers) . 

Anilin   (dye  makers). 

Chromium  (workers  in  chemical  works). 

Wood  alcohol  (varnishers,  polishers). 

Brass  (polishers). 

Mercury  (felt  hat  makers,  mirror  platers,  mak- 
ers of  mercury  vapor  lamps,  photographers). 

Phosphorus  (match  makers). 

(For  further  data  see  ''Industrial  Poisons,"  by  E.  F. 
McCampbell,  Ohio  State  Board  of  Health,  Columbus, 
Ohio.) 

Infections — 

Anthrax  (workers  wilh  hides  and  skins). 

Blood  Pressvrr. — 

''Roughly  speaking,  the  cases  with  blood  pressure 
permanently  above  200  m.m.  of  mercury  are  mainly 
those  of  increased  intracranial  pressure,  chronic 
nephritis,  and  aoi'tic  insufficiency;  those  between 
ir)0  and  200  iii.m.,  beside  these  conditions  are  arte- 
riosclerosis, Basedow's  disease,  elironie  ])olycythemia 
and  high  pressure  stasis."     (Ilirschl'elder.) 


^ 


FREQUENT   SYMPTOMS.  '^^ 


Hypotension. 


Acute  infectious  diseases. 

Shock  and  collapse. 

After  hemorrhage. 

After  severe  diarrhoea  or  dysentery. 

After  profuse  vomiting. 

In  pleurisy. 

In  pericarditis. 

All  acute  cardiac  disease. 

Chronic  mitral  stenosis. 

Cachectic  conditions. 

Cyanosis,  enlargement  of  the  liver  and  ascending  edema 
characteristic  of  failure  of  the  right  heart. 

Dyspnoea. — 

Dyspna-a  and  other  respiratory  disturbances  in 
heart  failure  are  due  chiefly  to  stasis  in  the  pul- 
monary capillaries  and  veins;  i.  e.,  due  to  pul- 
monary edema. 

An  early  sign  of  mitral  lesions.  In  aortic  lesions 
a  sign  of  broken  compensation ;  i.  e.,  of  secondary 
mitral  insufficiency. 

Cough,  dyspnoea,  cardiac  asthma,  pulmonary  edema, 
pulmonary  haemorrhage,  together  constitute  a 
group  of  symptoms  characteristic  of  stasis  in  pul- 
monary veins  (Hirschf elder). 

Cardiac  diseases. 

Tuberculosis  (pulmonary). 

Chronic  bronchitis. 

Pneumonia. 

Chronic  nephritis. 


38  CLINICAL    HISTORY   IN   OUTLINE. 

Asthma. 
Emphysema. 
Infectious  diseases. 
Exertion  and  excitement. 

Hcemoptysis. — 

Puhnonary  tuberculosis. 

Aneurism. 

Heart  disease. 

Pneumonia. 

Carcinoma. 

Bronchiectasis. 

HwmorrhageSy  Cutaneous. — 

Hemophilia. 

Purpura  ha*niorrhagica. 

Malignant  endocarditis. 

Henoch's  purpura. 

Scurvy. 

Nephritis. 

Diabetes. 

Foot-and-mouth  disease. 

Syphilis  (neonatorum). 

Schonlein  's  disease. 

Hcematemesis. — 

Peptic  ulcer  (gastric,  duodenal). 

Cirrhosis   (esophageal  hemorrhoids). 

Splenic  enlargements. 

Anaemic. 

Purpura. 

Typhoid. 

Aneurism. 


FREQUENT   SYMPTOMS.  39 

Hamaturia. — 

Renal — 

Acute  nephritis. 

Chronic  nephritis. 

Toxic  (turpentine). 

Infarction. 

New  growths. 

Tuberculosis. 

Nephrolithiasis. 

Filariasis. 

Bilharziosis. 

Pelvic  varices  (renal  epistaxis). 

Leukaemia. 

Ureteral — 
Calculi. 

Urethral — 

Acute  urethritis. 
Calculi. 

Vesical — 
Calculi. 
Acute  C3^stitis. 
Trauma. 
Tumors. 

Herpes. — 

Malaria. 

Cerebrospinal  fever. 

Pneumonia. 

Also  in  acute  miliary  tuberculosis  and  typhoid. 

Hypoiliermia. — 

Malaria. 

Convalescence  from  acute  fevers. 


40  CLINICAL    HISTORY    IN    OUTLINE, 

Collapse. 

Toxic  conditions  (opium,  alcohol). 

Cholera. 

Myxoedema. 

Diabetic  coma. 

Chronic  cardiac  disease. 

Cerebral  and  spinal  conditions. 

Idiosyncrasies. — 

Strawberry. 

Rhns  (poison  ivy). 

Crab  meat  and  shell  fish. 

Quinin,  morphin,  iodoform,  potassium  iodide. 

Certain  plants  or  grasses  (hay  fever,  rose  cold,  etc  ) 

Itching. — 

Quinin,  morphin. 
Diabetes. 
Jaundice. 
Pediculosis,  etc. 

Jaundice. — 

Epidemic  jaundice — Weil's  disease. 

Catarrhal. 

Gall-stone. 

Hypertrophic  cirrhosis. 

Hematogenic. 

Pancreatic  tumors  and  cysts. 

Carcinoma  of  liver,  stomach,  duodenum. 

Acute  yellow  atrophy. 

Icterus  neonatorum. 

Chloroform  necrosis  of  liver. 


FREQUENT   SYMPTOMS.  41 


Liver. — 

Enlarged  and  smooth. 

Chronic  passive  congestion. 
Amyloid. 
Cirrhosis. 
Fatty  liver. 
Enlarged  and  rough. 
Abscesses. 
Echinococcus. 
Syphilis  (gummata). 
New  growths. 
Cysts. 

Mydriasis. — 
Glaucoma. 
Optic  atrophy. 
Anaemias. 
Neurasthenia. 
-   Aortic  insufficiency. 
Irritation  of  cervical  sympathetic. 
Emotional  disturbances. 

Myosis. — 

Congestion  of  iris. 

Paralysis  of  cervical  sympathetic. 

Paralysis  of  fifth  nerve. 

Plethora. 

Venous  obstruction. 

Mitral  valve  disease. 

Spinal  disease. 

Pain 
General  Abdominal  Pain. — 

Constipation. 

Enteritis. 


42  CLINICAL   HISTORY    IN    OUTLINE. 

Appendicitis. 
T>T)lioid. 

General  peritonitis. 
Lead  poisoning. 
Intestinal  obstruction. 
Tuberculous  peritonitis. 
Tabes  crises. 

Extrauterine  pregnancy. 
Gastric  neuroses. 
Mucous  colitis. 
Gall-bladder  disease. 

Epigastric  Pain  (beside  the  above). — 

Acute  gastritis. 

Peptic  and  duodenal  ulcer. 

Hyperacidity. 

Pericarditis. 

Pancreatitis. 

Pyloric  adhesions. 

Left  Hypochondriac  Pain. — 

Flatulence. 

Angina  pectoris. 

Renal  suppurations  and  calculi. 

Sub-diaphragmatic  abscess. 

Right  Hypochondnac  Pain. — 

Chronic  hepatic  congestion. 
Gall-bladder  disease. 
Carcinoma  of  the  liver. 
Renal  suppuration  and  calculi. 
Sub-diaphragmatic  abscess. 


PAIN.  43 


Left  Iliac  Pain. — 

Pyosalpinx. 
Ectopic  gestation. 
Dysmenorrhcea. 
Ovarian  cysts. 
Ureteral  calculi. 
Sigmoid  carcinoma. 
Diverticulitis. 

Right  Iliac  Pain. — 

Appendicitis. 
Pyosalpinx. 
Dysmenorrhcea. 
Ectopic  gestation. 
Ovarian  cysts. 
Mucous  colitis. 
Chronic  colitis. 
Ureteral  calculi. 

Lumbar  Pain.- — 

Sacro-iliac  disease. 
Spondylitis. 
Spinal  arthritides. 
Strains. 
Herpes  zoster 
Lumbago. 
Psychoneuroses. 
Renal  suppurations. 
Renal  tumors. 
Spinal  tumors. 
Retroperitoneal  tumors. 
Fatigue. 


44  CLINICAL   HISTORY    IN    OUTLINE. 

Defective  balance,  scolioses,  etc. 

Infectious  diseases. 

Aneurisms. 

Pelvic  disorders. 

Tabes  dorsalis. 

Myelitis. 

Headache. — 

Aneurisms. 

Psychoneuroses. 

Nephritis. 

Meningitis. 

Sinusitis. 

Neuralgias. 

Syphilitic  periostitis. 

Brain  tumors. 

''Indurative"  headaches. 

Eyestrain. 

Indigestion  and  constipation. 

Menstruation. 

Onset  of  infectious  disease. 

Intoxications  (lead,  alcohol). 

Fatigue,  hunger,  bad  air. 

Tkoracic  Pain. — 

Digestive  disorders  (flatulence). 

Angina  pectoris. 

Hepatic  and  ])iliary  disorders. 

Aneurisms. 

Pleuritis  and  pneumonia. 

Pericarditis. 

Intercostal  ' '  rheumatism. ' ' 


PAIN.  45 


Herpes  zoster. 
Fractured  ribs. 

BracMal  Fain. — 
Arthritis. 
Bursitis. 
Neuritis. 
Angina  pectoris. 
Neuralgia. 
Osteomyelitis. 
Occupational  neuroses. 
Fractures. 
Cervical  rihs. 

Fain  in  Lrgs  and  Feet. — 

Flat  foot. 

Arthriticles. 

Varicose  veins. 

Phlebitis. 

Sciatica. 

Osteomyelitides. 

Sprains  and  strains. 

Syphilitic  periostitis. 

Tendosynovitis. 

Neuritis. 

Tumors. 

Gout. 

Metatarsalgia. 

Intermittent  claudication. 

Erythromelalgia. 

Figment  afio  n . — 

Lead  (lime  in  gums). 
Argyria. 


46  CLINICAL    HISTORY    IN    OUTLINE. 

Addison's  disease. 

Cachexias. 

Xanthomatosis. 

Chloromatosis. 

Melanoma  tosis. 

Tattooing. 

Gun  powder  burns. 

Sequelce  of  Infections  Disease. — 

Diptheria  (nephritis,  myocardial  disease,  paralyses). 
Scarlet  fever  (nephritis,  otitis  media). 
Articular   rheumatism    (mj^ocardial   disease,    endo- 
carditis, chorea). 
Whooping  cough  (pulmonary  tuberculosis). 
Measles  (pulmonary  tuberculosis). 
Gonorrhoea   (arthritis,  peritonitis,  endocarditis). 

Splenic  Enlargements. — 

Myelogenous  leukaemia. 

Malaria. 

Banti's  disease. 

Gaucher 's  splenomegaly. 

Lymphosarcomatosis. 

Ilodgkin's  disease. 

Acute  infections. 

Chronic  congestion. 

Amyloid. 

Syphilis. 

Vertigo. — 

Arteriosclerosis. 
Nephritis. 


PAIN.  47 


Meniere's  disease. 

Stokes-Adams'  disease. 

Transient  monoplegia  and  hemiplegia. 

Hemianopsia. 

Errors  of  refraction. 

Certain  gastric  disorders. 

Aortic  insnfficiency. 

Vomiting. — 

Gastric  neuroses. 

Appendicitis. 

Cardiac  diseases. 

Gastric  ulcer. 

Intestinal  obstruction. 

Gastric  cancer. 

Uraemia. 

Tabes  Dorsalis. 

Brain  tumors. 

Pregnancy. 

Acute  gastritis. 

Alcoholism. 

Onset  of  acute  infections. 

Post-operation. 

Errors  of  refraction. 


CHAPTER  IV. 

Post-Mortem  Examinations  and  Records. 
A  post-mortem  examination  is  the  final  method  of  sub- 
stantiating- a  elinioal  diagnosis.  The  application  of  this 
method  has  lead  to  collections  of  statistics  by  several  well- 
known  clinicians  who  have  discovered  that  their  clinical 
diagnoses  have  Ixn^n  imperfect  in  a  considerable  number 
of  instances. 

The  record  of  a  post-mortem  examination  is  the  last 
necessary  thing  in  the  complete  history  of  a  fatal  clinical 
case.  The  items  in  the  form  of  Post-Mortem  Record 
sliowji  on  ])ages  50,  51,  52  and  53,  which  is  a  duplicate 
of  that  used  ill  th(^  Cincinnati  Hospital,  indicate  the 
data  wliieli  should  be  secured  in  making  an  autopsy. 


(48) 


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(53) 


The  Mosby  Company's  New  Books  on  Diagnosis 


LABORATORY  METHODS 

With  Special   Reference  to  the   Needs  of  the  General 
Practitioner 

By    B.    G.    R.   WILLIAMS,    M.    D., 

Member  of  Illinois  State  Medical  Society,  American  Medical  Association,  Etc. 

Assisted  by   E.  G.  C.  WILLIAMS.   M.   D., 

Formerly  Tathologist  of  Northern  Michigan  Hospital  for  the  Insane, 
Traverse  City,  Michigan,  Etc. 

With  an  Introduction  by 
VICTOR   C.   VAUGHAN,    M.   D.,    LL.D.. 

Professor  of  Hygiene  and  Thysiological  Chemistry  and  Dean  of  the  Depart- 
ment   of   Medicine    and    Surgery,    University    of    Michigan ;    Tresident- 
Elect    of   the   American   Medical   Association. 

SECOND    EDITION,    REVISED    AND    REWRITTEN. 

Octavo,  250  pages,  with  50  engravings.  Cloth,  $2.50 


Milk  and  Its  Home  Modifi- 
cations. 

Some  Simple  Water  Anal- 
yses. 

Every-Day  Stool  Tests. 

Technic  of  the  Private  Post- 
Mortem. 

To  Find  the  Treponema  in 
Six   Minutes. 

Laboratory  Prophylaxis. 

Indications  for  Laboratory 
Aids. 

Tables  and  Miscellaneous. 

FROM    REVIEWS 

This  book  may  be  freely  commended  to  those  who  may  desire  a  working 
guide  to  the  more  usual  laboratory  methods.  The  style  is  clear  and  concise, 
anB  the  general  makeup  of  the  book  is  excellent, — .Tournal  of  the  American 
Medical  Association. 

General  practitioners  are  under  an  everlasting  debt  of  gratitude  to  the 
Williamses  for  their  textbook.  Any  publication  which  lightens  the  burdens 
of  these  physicians  and  points  out  a  way  to  bettering  their  work  is  bound 
of  necessity  to  succeed. — Maryland  Medical  Journal. 


CONTENTS 

Chapter 

Chapter 

I. 

General    Considerations. 

XI. 

II. 

The  Sputum. 

III. 

Searching  for  Germs. 

XII. 

lY. 
Y. 

Yascular   Dramas. 
Chemistry     and     Biology     of 

XIII. 
XI Y. 

the  Gastric  .Juice. 

YI. 

Essence  of  Tissue  Diagnosis. 

XY. 

YII. 

Detection     of     the     Common 

YIII. 

Poisons. 
Exudates  in  Brief. 

j        XYI. 

;    xYii. 

IX. 

Diazo  Yersus  Widal. 

X. 

The  Urine  in  Disease. 

XYIII. 

The  Mosby  Company's  New  Books  on  Diagnosis 


TUBERCULIN 

In  Diagnosis  and  Treatment 

By   FRANCIS   MARION   POTTENGER,   A.   M  .    M.   D.,    LL.D., 

Medical  Director  of  the  Pottenger  Sanatorium  for  Diseases  of  tlie  Lungs  and 
Throat,  Monrovia,  California. 

Octavo,  250  pages,  with  35  engravings  and  1  color  plate. 
Price,  Cloth,  $2.50. 


CONTENTS 


Chapter 

I.  Importance  of  the  Tuber- 
culin Test  in  the  Early 
Diagnosis  of  Tuberculo- 
sis. 

II.     Subcutaneous   Tuberculin 
Test. 

III.  C  u  t  a  neous     Tubei'culin 

Test. 

IV.  Percutaneous    Tuberculin 

Test. 
V.     Conjunctival      Tuberculin 

Test. 
VI.     Tuberculin  in  the   Treat- 
ment of  Tuberculosis. 
VII.     Hypersensitiveness. 


Chapter 
VIII. 


IX. 


X. 


XI. 


XII 


Appendix. 


Certain  Conditions  Which 
Have  Made  the  Adoption 
of  Tuberculin  as  a  Di- 
agnostic and  Therapeu- 
tic Measure  Difficult. 

Evidences  of  the  Thera- 
peutic Value  of  Tuber- 
culin. 

Fever  in  its  Relationship 
to  Tuberculosis. 

Temperature      Curve      in 

Tuberculosis. 
Technic    of  Administering 
Tuberculin. 

Koch's  Announcement  of 
the  Discovery  of  Tuber- 
culin. 


FROIVI    REVIEWS 

This  book  by  Pottenger,  who  has  long  been  recognized  as  an  authority  on 
everything  pertaining  to  pulmonary  tuberculosis,  contains  about  everything 
worth  knowing  at  the  present  time  on  the  use  of  tuberculin  in  both  diagnosis 
and  treatment.  It  is  a  book  of  great  value  not  only  to  the  specialist,  but 
also  to  the  general  practitioner. — .lournal  of  the  Michigan  State  Medical  As- 
sociation. 

We  have  enjoyed  reading  this  work.  Dr.  Pottenger  has  the  reputation  of 
being  e.xceptionally  thorough  in  his  diagnostic  work  and  we  are  given  the 
benefit  of  this  in  the  book.  The  author  makes  it  plain  that  the  use  of  tuber- 
culin for  diagnostic  purposes  is  corroborative  only,  that  to  in  any  measure 
neglect  the  history  and  physical  findings  invites  failure.  M'e  heartily  rec- 
ommend thus  book  to  the  attention  of  general  practitioners. — Journal  of  the 
Iowa  State  Medical  Association. 


The  Mosbu   Company's  Xcic  Books  on  Diagnosis 


THE  WASSERMANN  REACTION 

Its  Technic  and  Practical  Application  in  the  Diagnosis  of 

Syphilis 

By   JOHN    W.    MARCHILDON,    B.   S.,    M     D., 

Assistant  Professor  of  Bacteriology,  St.  Louis  University  Medical  School, 

St.   Louis. 

Id.")    payes,    with    11    illustrations    and    1    colored    frontispiece. 

Price,  Cloth,  $1.50. 


CONTENTS 


Chapter 

I.     Materials    Required    for    Mak- 
ing    the     Was«3rmann     Re- 
action. 
II.     The  Preparation  of  the  Hem- 
olytic  Amboceptor    or    Hem- 
olysin. 
III.     The    Preparation    of    Comple- 
ment. 
lY.     The  Preparation  of  Red  Blood 

Corpuscles. 
y.     The     Preparation     of     Serum 

from  the  Patient. 
YI.     The   Preparation  of  the  Anti- 
gen. 


Chapter 

YII.     To    Obtain    the    Dosage    of   an 
Extract. 

YIII.     The  IMethod  of  Making  a  Was- 
sermann  Reaction. 
IX.     The  Modification  of  the  Was- 

serraann  Reaction. 
X.     The  Wasserniann   Reaction   in 

Syphilis. 
XI.  The  \Yassermann  Reaction  in 
Diseases  other  than  Syphilis. 
XII.  The  Influence  of  Anti-Syphi- 
litic Treatment  on  the  Was- 
serniann Reaction 


FROM    REVIEWS 

^Ye  can  commend  this  excellent  little  work  to  those  who  wish  to  become 
more  independent  of  the  larger  laboratories  and  to  place  themselves  in  a  posi- 
tion better  to  understand  and  perform  this  most  important  diagnostic  test. — 
Journal  American  ^ledical  Association. 

This  volume  should  be  on  the  shelves  of  every  physician. — Interstate  Medi- 
cal  Journal. 

We  commend  the  work  to  those  of  our  readers  interested  (and  what  physi- 
cian is  not)  in  the  accurate  diagnosis  of  syphilis. — The  American  Practitioner. 

This  little  volume,  big  enough,  sets  forth  in  clear  terras  the  technic  of  the 
Wassermann  reaction.  The  author  has  peeled  away  much  that  was  designed 
to  befog  the  man  of  limited  acquirements  in  the  laboratory,  thereby  enabling 
the  man  of  patience  and  average  ability  to  do  all  of  his  own  laboratory  work. 
Hi?  style  is  clear,  cogent  and  apt  to  teach. — Journal  of  the  Texas  State  ^ledi- 
cal  Association. 

This  primer  of  the  Wassermann  reaction  can  be  recommended  as  a  very 
clear  and  concise  statement  of  the  rationale  and  technic  of  that  complicated 
test. — American  Journal  of  Surgery. 


The  Moshij  Company's  Nciv  Books  on  Diagnosis 


VACCINE  AND  SERUM  THERAPY 

Including   also   a   Study   of   Infections,  Theories  of   Immunity, 
Specific   Diagnosis,  and   Chemotherapy 

By    EDWIN    HENRY    SCHORER, 

B.   S.    (University  of  Wisconsin),   M.   D.    (Johns  Hopkins  University), 
Dr.  P.   H.    (Harvard  University). 

Formerly    Assistant    Tliomas    Wilson    Sanitarium    for    Children,    Mt.    Wilson, 

Maryland;  Asst.  Rockefeller  Institute  for  Medical  Research,  New  York 

City;  and  at  one  time  Member  of  the  Faculty  of  the  University  of 

Missouri,  of  the  University  of  Kansas,  and  of  the  Department 

of  Preventive  Medicine  and  Hygiene  of   Harvard 

University,  Boston. 

Octavo,  2.50  pages,  with  18  engravings  and  a  colored  plate. 

Price,  Cloth,  $3.00. 

SECOND   REVISED    EDITION. 


Chapter 

I. 

Infections. 

II. 

Immunity. 

III. 

Specific  Diagnosis. 

IV. 

Specific    Therapy. 

CONTENTS 
Chapter 


V.     Specific  Diagnosis,  Treat- 
ment and  Prophylaxis  in 
the  Different  Infections. 
Appendix.     Syphilis  and  Malaria. 


FROM    REVIEWS 

It  contains  all  that  is  necessary  for  physicians  to  know  about  this  new 
and  fascinating  method  of  treatment.  The  text  is  well  done  and  the  illustra- 
tions are  adequate.  Doctor  Schorer  has  had  a  large  and  varied  experience 
and  is  the  master  of  the  technique  of  the  laboratory. — The  Canadian  Medical 
Association  Journal. 

The  whole  subject  has  been  treated  in  a  very  practical  and  comprehensive 
manner,  and  we  heartily  recommend  the  book  to  all  who  may  be  interested 
in  tlie  subject. — Journal  of  the  Indiana   IMedical  Association. 

This  revised  second  edition  will  be  welcomed  by  all  interested  in  the 
treatment  of  disease,  medical  and  sui-gical.  Altogether  this  will  prove  u 
valuable  addition  to  the  literature  on  vaccine  and  serum  therapy.— The 
American  Practitioner. 


The  Mosby  Company's  New  Books  on  Diagnosis 


DIAGNOSTIC  METHODS 

A    Guide    for    History    Taking,    Making    of    Routine    Pliysical 

Examinations  and  the  Usual  Laboratory  Tests  Necessary 

for  Students  in  Clinical  Patliology,  Hospital  Internes, 

and   Practicing   Physicians 

By  HERBERT  THOMAS  BROOKS,  A.  B.,  M.  D., 

Professor  (jf  I'athology,   University  of  Tennessee,   College  of  Medicine, 
Memphis,   Tennessee. 

SECOND    EDITION,    REVISED    AND    REWRITTEN. 
85   pages,    Limp    Binding,   Price,   $1.00. 


CONTENTS 


Chapter 

I.     Outline  for  History   Taking. 
II.     Physical    Examination    of    the 
Patient. 

III.  Sputum. 

IV.  Urine. 

V.     Gastric  Contents. 
VI.     Blood. 
VII.     Serous  Fluids. 


Chapter 

VIII.     Intestinal  Contents. 
IX.     Tuberculin   Diagnosis. 
X.     The    Wassermann    Reaction. 
XI.     Complement  Fixation-  Test  for 

Gonorrhea. 
XII.     Apparatus   and   Chemical   Re- 
agents Necessary  for  Physi- 
cian's Laboratory. 


FROM    REVIEWS 

An  excellent  laboratory  guide  for  the  practitioner  who  needs  a  brief  re- 
view of  his  laboratory  technique.  It  is  equally  good  as  a  working  guide  to 
the  student.  The  study  of  its  first  pages  will  benefit  the  student  or  interne 
in  taking  histories-. — Illinois  Medical  .Journal. 

It  is  a  clear,  trustworthy  exhibition  of  the  simplest  and  best  method  of 
laboratory  diagnosis.  Following  it  closely  any  high-school  pupil  could  do  the 
Wassei'mann  reaction.  No  matter  how  many  books  on  diagnosis  one  may 
have,  this  book  will  prove  a  valuable  addition. — Texas  State  .Journal  of 
Medicine. 


The  Moshy  Company's  Neio  Books  on  Diagnosis 


ARTERIOSCLEROSIS 

Etiology,   Pathology,    Diagnosis,    Prognosis,    Phophylaxis 
and   Treatment. 

With  a  Special  Chapter  on   Blood   Pressure 

By   LOUIS   M.   WARFIELD,   A.   B.,   M.   D.. 

Assistant  Superintendent  and  Resident  Physician,  to  Milwaukee  County  Hos- 
pital ;  Assistant  Professor  of  Medicine,  Wisconsin  College  of  Physicians 
and  Surgeons,  Milwaukee;  Formerly  Medical  House  Officer, 
Johns  Hopkins  Hospital,  Baltimore,  Md. 

With   an    Introduction 

By    W.    S.    THAYER,    M.    D., 

Johns  Hopkins  University. 

221)  pages,  with  28  engravings. 

SECOND    REVISED    EDITION. 
Price,   $2  50. 


CONTENTS 


Chapter 

I.     Anatomy. 
II.     Physiology  of  the  Circulation. 

III.  Pathology. 

IV.  Etiology. 

V.     The   Physical   Examination    of 

the  Heart  and  Arteries. 
VI.     Symptoms  and  Physical  Sings. 
VII.     Symptoms  and  Physical  Signs 
— Continued. 


Chapter 

VIII.     Diagnosis  and  Differential  Di- 
agnosis. 
IX.     Prognosis. 
X.     Prophylaxis. 
XI.    Treatment. 
XII.     Arteriosclerosis  in  Its  Relation 

to  Life  Insurance. 
XIII.     Practical   Suggestions. 


FROM    REVIEWS 

It  will  surely  be  found  useful,  especially  in  those  chapters  which  deal  with 
prophylaxis  and  practical  suggestions  as  to  treatment. — Johns  Hopkins  Hos- 
pital Bulletin. 

Dr.  Warfleld  has  brought  together,  in  ,i  compact  volume,  a  very  readable 
account  of  modern  views  on  the  subject,  and  makes  many  suggestive  observa- 
tions,  which   deserve   further   attention. — British   Medical   Journal. 


The  Moshy  Company's  Neio  Books  on  Diagnosis 


MUSCLE  SPASM  AND  DEGENERATION  IN 
INTRATHORACIC  INFLAMMATIONS 

Their   Importance   as    Diagnostic   Aids  and   Tiieir    Influence    in 

Producing   and   Altering  the   Well    Established    Physical 

Signs,   also   a  Consideration   of  Their   Part   in   the 

Causation   of  Changes  in  the   Bony  Thorax 

AND  LIGHT  TOUCH  PALPATION 

The     Possibility     and     Practicability     of     Delimiting     Normal 

Organs  and  Diagnosticating  Diseased  Conditions  Within 

the  Chest  and  Abdomen  by  Very  Light  Touch 

By    FRANCIS    MARION    POTTENGER,    A.    M.,    M.    D.,    LL  D.. 

Medical  Director  of  the  Pottenger  Sanatorium  for  Diseases  of  the  Lungs  and 
Throat,  Monrovia,  California. 

110  pages,  with  sixteen  original  illustrations. 
Price,  Cloth,  $2.00. 


CONT 

Chapter 

I.  Spasm  and  degeneration  of  the 
muscles  of  the  neck  and 
thorax  in  the  presence  of 
intrathoracic    inflammations. 

II.     Cause    of    muscle    spasm    and 

degeneration. 
III.  What  can  be  determined  by 
noting  the  condition  of  the 
neck  and  chest  muscles  in 
acute  and  chronic  inflam- 
mations of  the  lungs  and 
pleura. 

IT.     Effect    of    muscle    spasm    and 
degeneration. 

V.  Cause  of  lagging  as  a  sign 
of  apical  involvement. 


ENTS 
'    Chapter 

VI.     Cause     of     flattening     of     the 
che.st    wall    on    the    affected 
side. 
YII.     The    relation    of    the    muscle 
change   to   the   anomalies   of 
the    upper    aperture    of    the 
thorax. 
YIII.     Neck,     chest,     and     shoulder 
pains   of  reflex   origin. 
IX.     The    effect    of   muscle    change 
upon    percussion   findings    in 
the  physical   examination  of 
the    chest. 
X.     The    effect    of    muscle    change 
upon  the  data  derived  from 
auscultation. 
XI.     Light  touch  palpation. 


FROM    REVIEWS 

A  casual  review  cannot  do  this  book  ]u»tice  ;  the  thanks  of  the  profession 
are  due  to  the  author  and  publisher  for  such  a  valuable  piece  of  literature 
in  the  field  of  diagnosis.  It  is  like  a  refiner's  furnace  to  the  old  methods 
of  physical  examination  and  shows  the  refined  possibilities  of  light  touch 
palpation. — Journal    of  the   Texas   State   Medical    Association. 

Pottenger  gives  a  logical  explanation  of  careful  observations  of  the 
chest  in  disease,  and  the  book  will  be  of  value  to  all  who  are  keenly  inter- 
ested in  physical  diagnosis. — .Journal  of  the  American  Medical  Association. 


The  Mosby  Company's  New  Books  on  Diagnosis 

GENITOURINARY  DIAGNOSIS  AND 

THERAPY 

For   Urologists  and    General    Practitioners.      Including   also   a 

Chapter  on  "The  Serological   Diagnosis  and  Specific 

Treatment  of  Gonococcic   Infections" 

By    DOCTOR    ERNST    PORTNER, 

Specialist  for   Urology,   Berlin,   Germany. 

Translated  and  Edited  by 

BRANSFORD   LEWIS,   M.  D.,  B.  Sc, 

Professor  of  Genito-urinary   Surgery,   Medical  Department  of  St.   Louis  Uni- 
versity, St.  Louis ;  Genito-urinary  Surgeon  to  St.  John's  Hospital  and 
Frisco  Hospital ;  Member  American  Urological  Association ;  Ameri- 
can Association  of  Genito-urinary  Surgeons ;  American  Medical 
Association,   Etc. 

240  pages,  with  43  engravings. 
Price,  Cloth,  $2.50. 


CONTENTS 


Chapter 

I.  Disinfection  of  Urologic  In- 
struments. 

Anesthesia    in   TTrology. 

Lubricants. 

Catheterization  of  the  Male. 

Diseases  of  the  I'rethra  and 
Penis. 

Diseases  of  the  Testes  and 
Epididymis. 

Diseases  of  the  Prostate  Gland 

Diseases  nf  the  Seminal  Ves- 
icles. 


II. 
III. 
IV. 

V. 

VI. 

VII. 
VIII. 


Chapter 

IX.     Diseases  of  the  Urinary  Blad- 
der. 
X.     Diseases  of  the  Kidneys. 
XI.     Diseases  of  the  Ureters. 
XII.     Disturbances    of    the    Genital 
Function  in  the  Male. 

XIII.  Diseases    of   the    Urinary    Or- 

gans in  the  Female. 

XIV.  Diseases    of    the    Urinary    Or- 

gans in  Childhood. 
XV.     The  Serological  Diagnosis  and 
S|)ecifi('  Treatment  of  Gono- 
coccic Infections. 


FROM    REVIEWS 

This  book  sets  forth  in  concise— even  terse— terms  the  best  practice  in 
dealing  with  diseases  of  the  genito-urinary  system. — The  Canadian  Medical 
Association  Journal. 

Tiie  mere  fact  that  Doctor  Lewis  has  considered  it  wnrtli  while  to  trans- 
late and  edit  Portnor's  book  is  sufficient  reconnnendation  to  ensure  its  accep- 
tance and  approval  by  American  practitioners.— New  York  Post-Graduate 
Medical  JournaL 


i<V^ 


